Multiple socioeconomic, structural and operational factors were associated with unvaccinated rates, highlighting the relevance of healthcare service organization even in favorable social contexts and classifying municipalities into risk profiles may help guide interventions to improve coverage.
ABSTRACT Objective: To evaluate the spatio-temporal variation of childhood immunobiological vaccine coverage in the municipalities of the Northern region of Brazil, comparing cross-sectional data from 2018 and 2022, and its association with socioeconomic and maternal variables. Methods: This is a comparative ecological study with coverage data for seven immunobiologicals in the municipalities of the Northern region for the years 2018 and 2022. Data were obtained from the Department of Informatics of the Unified Health System. Spatial analysis (global, bivariate, and local Moran’s Index) was used to verify the association between vaccine coverage and independent variables (GDP per capita, Brazilian Deprivation Index, maternal schooling, proportion of indigenous people, full-term births, and birth weight). Results: There was a widespread decline in vaccine coverage when comparing the two periods, except for the meningococcal C vaccine. Vaccination was positively associated with GDP per capita and maternal schooling, and negatively associated with the Deprivation Index, with these associations intensifying over the period. The spatial correlation between immunization and the proportion of the indigenous population, previously not significant, became strongly negative in 2022. Clusters of low immunization and socioeconomic vulnerability were identified mostly in the states of Pará and Amazonas, and clusters of high immunization and better indicators in Tocantins and Rondônia. Conclusion: The decline in childhood vaccination in the Northern region is a spatially structured phenomenon that reflects and deepens socioeconomic inequalities. The formation of vulnerability clusters, especially in areas near the Brazilian border, represents a risk for the re-emergence of vaccine-preventable diseases and demands territorially focused public health policies.
Eduarda de Paulo Costa, Luiz Fernando Costa Nascimento· Revista brasileira de epidem...· 0 citations
Background: Vaccinations are highly effective in preventing infectious diseases, which otherwise present a serious challenge to the health of individuals and public health. To identify potential gaps in vaccination coverage, we examined childhood vaccination levels in Frankfurt am Main (FFM) and the Rhein Neckar district (including Heidelberg city, RNHD) prior to, during and following the COVID-19 pandemic. Moreover, we explored various factors that appear to contribute to lower vaccination levels in specific communities in either or both locations. The results are intended to guide strategies for designing and improving vaccination services for specific groups in local health settings. Methods: A retrospective analysis was conducted to examine the vaccination rates of children in Frankfurt am Main and the Rhein Neckar district (including Heidelberg city) by using anonymized data from school entry examinations spanning the years 2017 to 2024. Data pre-processing, analysis, and visualization were performed using R (5.4.2). Frequencies and percentages were calculated for sociodemographic and vaccination rates (the completeness of the vaccination schedule recommended by STIKO for children). Multivariate logistic regression was performed to determine factors with a significant impact on vaccination uptake. Results: Multinomial logistic regression with ‘measles-only’ (Measles) as the reference category revealed distinct predictor patterns across vaccination levels. In both regions, children who completed preventive medical check-ups had higher odds of completing the schedule of vaccination plus at least one additional vaccine (ScheduledPlus) versus, measles-only vaccination. In RNHD, children from Eastern European language families and low- and medium-social-status backgrounds showed higher odds of completing the scheduled vaccinations without the recently introduced rotavirus vaccination (ScheduledNotRota), versus measles-only vaccination. In FFM, strong interaction effects were observed between medical examination completion and migration background, with children from non-German birthplaces showing dramatically reduced odds of complete vaccination when preventive care was incomplete. Discussion: The proportion of children with a complete vaccination status remained stable over the study period in both locations, with no evidence of post-pandemic decline. Nevertheless, this stability masks important heterogeneity in vaccine coverage patterns across sociodemographic groups. Systematic identification and modeling of interactions between nationality, parental employment, and healthcare utilization tell a compelling “double jeopardy” story that the effects of these risk factors are not additive but synergistic. Regular medical check-ups remain an important factor in ensuring high vaccination coverage among children until they start school and underscore the justification for such established preventive care programs. A nuanced understanding, however, is crucial for moving beyond simplistic, one-size-fits-all public health messaging.
C. Dyer, Judith Welker, K. Assaad et al.· Vaccines· 0 citations
Relevance.
Vaccination remains the most effective measure for controlling pertussis spread; however, immunization strategies may require revision in light of changing disease patterns.
Aims
. To identify current trends in pertussis incidence in the Russian Federation and propose modifications to vaccination strategies.
Materials and methods
. The study was based on analysis of statistical forms "Data on infectious and parasitic diseases" (Form No. 2) and "Data on populations of children and adults vaccinated against infectious diseases" (Form No. 6) for 2013–2025, as well as medical records of 535 infants who experienced pertussis during their first year of life in Moscow in 2023–2025.
Results.
Pertussis incidence in the Russian Federation demonstrates a sustained upward trend (average annual growth rate: 9.79 %), with infants under one year remaining the most vulnerable group, accompanied by an increase in pertussis-related mortality. Against this background, a substantial proportion of cases occurs among population groups most frequently serving as sources of infection for infants: during the study period, children aged 7–14 years accounted for 33–44 % of cases, while the share of adult cases increased (17 % nationally and 31 % in Moscow in 2025), substantiating the need for national implementation of age-targeted booster vaccination. The unfavorable epidemiological situation is exacerbated by delays in infant immunization (coverage < 50 % by the end of the first year of life) and low adherence to series completion among children following natural infection (among children who experienced pertussis in 2023, only 11.2 % continued immunization; in 2024 — 50.7 %; in 2025 — 7.6 %).
Conclusions
. To stabilize the situation, critical measures include: implementation of booster vaccination for school-aged children; mandatory maternal immunization to provide transplacental protection to newborns; and strict adherence to completion of vaccination series for children following pertussis infection.
A. V. Prokopenko, A. V. Lomonosova, A. I. Dzhepko· Epidemiology and Vaccinal Pr...· 0 citations
Measles remains a significant cause of childhood mortality globally. Despite effective vaccines, the World Health Organisation reported an estimated 10.3 million measles cases worldwide in 2023, a 20% increase from 2022, primarily due to insufficient vaccination coverage. Madagascar faced a major measles epidemic in 2018–2019, prompting vaccination efforts. A convergent parallel mixed-methods design was utilised, wherein quantitative household surveys and semi-structured qualitative interviews were conducted concurrently. Data were integrated during the interpretation phase to triangulate statistical determinants with contextual stakeholder insights regarding the performance of the October 2024 measles vaccination campaign and its determinants across different geographical areas. This retrospective, cross-sectional Post-Measles Campaign Evaluation (PMCE) was conducted from December 2024 to April 2025, following the October 2024 campaign. It involved quantitative household surveys and qualitative interviews in all 23 regions of Madagascar, targeting children aged 9–59 months and their caregivers. A two-stage stratified random sampling approach distinguished large cities, landlocked, and intermediate districts. Multivariate logistic regressions were performed to identify geographical, socio-demographic, economic, and cultural determinants of post-campaign vaccination coverage. The study revealed a national post-campaign vaccination coverage of 75.3% in 2024, a notable 10-point increase from 65.3% in 2022. However, significant geographical disparities persisted (p-value = 0.0233), with lower coverage in large cities (63.2%) compared to landlocked (78.4%) and intermediate (76.2%) districts. Multivariate analysis showed that residing in a large city significantly reduced post-campaign vaccination coverage (OR adjusted = 0.25; p = 0.010). Conversely, male child gender (OR adjusted = 1.33; p = 0.040), birth in a health facility (OR adjusted = 1.38; p = 0.046), possession of a birth certificate (OR adjusted = 2.30; p < 0.001), having a Christian caregiver (OR adjusted = 1.92; p < 0.001), or a housewife caregiver (OR adjusted = 1.97; p = 0.015) were associated significantly higher post-campaign vaccination coverage. The identified statistical determinants, notably the lower coverage among urban residents (ORa = 0.25), were contextualised using qualitative data, which highlighted that ‘urban vaccine hesitancy’ is exacerbated by metropolitan misinformation and the misconception that previously vaccinated children did not require campaign doses. While Madagascar's post-campaign measles vaccination coverage shows encouraging progress, significant geographical and socio-demographic disparities underscore the need for tailored strategies. Addressing urban-specific challenges, strengthening communication, improving logistics, and leveraging community engagement are crucial for achieving equitable immunisation coverage and advancing towards measles elimination targets.
F. Alain, Faly Hariniaina Randrianasolo, M. Razafimahatratra et al.· PLOS Global Public Health· 0 citations
Abstract Introduction Despite global progress in immunisation, vaccine coverage remains uneven in many low- and middle-income countries. Urbanisation has widened disparities, particularly among children in informal settlements. Ethiopia has a high zero-dose burden, with the Somali region identified as a hotspot. However, urban areas in this region remain understudied. This study assesses the prevalence of zero-dose children and associated factors in urban areas of the Somali region to inform targeted interventions. Methods Using a mixed-methods approach, data were collected from 842 households in three urban towns through community surveys and six key informant interviews. The primary outcome was the proportion of zero-dose children, defined as those who had not received the first dose of the DTP-containing vaccine (Penta-1) during their first year of life, based on vaccination card records or caregiver recall. This included children who had never received any vaccine or had received some vaccines but not Penta-1. Quantitative data were analysed using logistic regression, while qualitative findings were examined thematically using the GAVI IRMMA framework. Strict quality control measures ensured the reliability of results. Results Of 842 targeted households, 827 participated (98.2% response). Findings reveal that 30% of children surveyed were identified as zero-dose for vaccination. Children were significantly more likely to be zero-dose if their mothers had no antenatal care (adjusted OR, AOR ~5.0), required permission for vaccination (AOR ~3.4), delivered at home (AOR ~3.1), or did not receive the second dose of tetanus toxoid (AOR ~2.7). In contrast, higher perceived household wealth and at least one postnatal care visit reduced the likelihood of zero-dose by about 45% and 55%, respectively. Zero-dose children were concentrated in urban peripheries and informal settlements with limited healthcare access, poor identification strategies and reliance on facility-based vaccination services. Conclusions The study highlights a higher prevalence of zero-dose children in urban areas, underscoring the urgent need for improved identification and mapping in underserved communities. Strengthening advocacy, diversifying immunisation approaches and addressing systemic barriers are essential to improving vaccine access and reducing the zero-dose burden.
A. Elmi, Mahamed Ibrahim, A. Farah et al.· BMJ public health· 0 citations
Background and objectives Globally, measles cases remain above 10 million despite the introduction of two dose measles vaccination schedule since 2000. India reported 13220 cases during 2023-2024, ranking fourth globally. This raises concern regarding the effectiveness of the ongoing programme to achieve measles elimination. Tribal dominated regions in countries such as India needs particular attention due to their higher burden of childhood morbidity and mortality. This study aimed to estimate the proportion of children developing protective antibody levels following two doses of measles vaccine in a tribal location and to identify potential risk factors associated with non-response. Methods A tribal dominated region, the undivided Phulbani district of Odisha, India, was randomly selected. Using cluster sampling, 1375 Infants aged 8 months were enrolled from 30 tribal habitations and followed to document vaccination status. Blood samples (n=1185) were collected three months after the second measles vaccine dose, and their measles IgG antibody levels were quantified. Variables likely to influence antibody response were recorded and statistically evaluated. Results Two-dose measles vaccine coverage was 99.6%; however, 55.1% (n=653) of children demonstrated seropositivity (IgG titre ≥ 250 IU/L). Male gender was significantly associated with suboptimal antibody response. Age, nutritional status, interval between first and second vaccine doses, and vaccination logistics were not found to influence antibody response. Interpretation and conclusion This study provides the first evidence of suboptimal measles antibody response among children from a tribal area of Odisha, India, despite high vaccination coverage. There is a need to understand the immune persistence among such a vulnerable population, where measles control remains a challenge.
B. Dwibedi, Gayatri Patra, Abhilipsa Behera et al.· The Indian journal of medica...· 0 citations